PURPOSE We wanted to understand patients' views about physician interventions with family violence and confl ict.METHODS Clinic staff surveyed 253 male and female family practice patients in 6 member offi ces of the South Texas Ambulatory Research Network (STARNet). The survey instrument addressed demographics, relationship quality, intimate partner violence, and physician interventions with family confl ict. Open-ended questions asked respondents to provide advice for "doctors who want to help patients with severe family problems." RESULTS Among women in relationships, 10% reported being physically hurt by a partner in the past year and 39% in their lifetimes. Among men in relationships, 7% reported physically hurting their partner in the past year and 16% in their lifetimes. Nearly all respondents, including 100% of victims and perpetrators of violence, believed physicians should ask about family confl ict (96%), and that physicians could be helpful (93%). Two thirds of the sample reported that their physician had never asked them about family confl ict. Investigators used qualitative analysis to summarize patients' advice to physicians. Responses clustered around 3 general themes: communication, assistance, and cautions or encouragement. Patients want physicians to ask about family confl ict, listen to their stories, and provide information and appropriate referrals. They raised some cautions and concerns, but also provided words of encouragement. CONCLUSIONMost patients are open to discussions about family confl ict with their physicians. The skills they recommend to physicians are well within the domain of family medicine training.

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More than 90% of pediatric acquired immune deficiency syndrome (AIDS) cases are due to mother-to-child (vertical) transmission. Medical intervention can reduce the risk of vertical transmission human immunodeficiency virus (HIV) from 25% to less than 8%. However, studies have suggested that approximately one-fourth of women may refuse HIV testing as part of routine prenatal care. The purpose of this study was to identify concerns that pregnant women might have that would impact their decision to undergo HIV testing in pregnancy. The study is a cross-sectional survey of 413 pregnant women in south Texas. A survey questionnaire was used to assess reasons why subjects might avoid HIV testing and to assess their risks for HIV infection. The reasons for not wanting HIV testing grouped around four themes: (1) fear of being stigmatized as sexually promiscuous or as an injecting drug user; (2) denial about the possibility of being infected; (3) fatalism; and (4) of rejection leading to loss of emotional and financial support. Overall, 15% of subjects who had not been previously tested (5% of all subjects) indicated that they would refuse HIV testing, a rate which is below rates of 20%-24% in previous studies. The lower rate of refusal for HIV testing in our study may reflect a downward trend nationally in the rate of refusal for prenatal testing. Many women have concerns about HIV testing, although these concerns may not necessarily prevent them from undergoing testing. Physicians and policy makers need to be aware of women's concerns and fears when implementing HIV testing policies.

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